The patient-centered medical home (PCMH) model ― also referred to as advanced primary care and the healthcare home ― holds promise as a way to improve American healthcare by transforming how primary care is organized and delivered. This team-based model of care is led by a personal physician who ideally provides continuous and coordinated care throughout the patient’s lifetime to maximize health outcomes. The PCMH practice is responsible for all of a patient’s healthcare needs or appropriately arranging care with other qualified professionals. This includes the provision of preventative services, treatment of acute and chronic illness, and assistance with end-of-life issues.
KEY PRINCIPLES
The American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association agreed on a common definition in the 2007 Joint Principles for the Patient Centered Medical Home.
Key principles of the PCMH model include:
- Personal relationship. Each patient has an ongoing relationship with a personal physician and a healthcare team ― such as nurses, counselors, and social workers ― who provide continuous and comprehensive care.
- Team approach. Each member of the healthcare team, including the clinical support staff, takes responsibility for the patient’s care.
- Expanded access. Access to care is available through scheduled and same-day appointments, communication takes place between the patient, physician, healthcare team and support staff via email and telephone, and patients also have secure access to their own health records online.
- Comprehensive care. Each healthcare team manages a broad range of healthcare needs for patients of all ages and care is arranged with specialists when necessary.
- Coordinated care. Care is coordinated with specialists and outside services to assure that the patient gets the best possible care.
- Quality and safety. The entire medical home team is involved in continuous quality improvement base on patient and staff input.
The PCMH model seeks to foster a relationship of trust between the care team and the patient, and to actively engage patients as partners in their health care. Care coordination is an essential component of the PCMH model and requires additional resources such as health information technology and appropriately trained staff to provide coordinated care through team-based models.
FACILITY IMPACT
From a facility perspective, the goal is to decrease the level of stress from home to the exam/consult/treatment room to encourage patient self-disclosure and to optimize the interaction with the provider. This should begin with intuitive wayfinding, appropriate building “drop off” points and access, welcoming reception area, and a comfortable waiting area. The facility must be designed with the flexibility to provide a variety of technologies and spaces to allow patients, partners, and the interdisciplinary care team to select the best method for assessment, development, and implementation of the patient’s plan of care.
Specific spaces may be needed for:
Group medical visits ― to accommodate six to ten persons around a table or in a more open room configuration ― with direct access to a handwashing sink, toilet room, scale, specimen processing counter, and an exam room.
Group education visits ― with direct access to/from the public waiting area and toilet facilities without entering clinical or administrative areas. Group education rooms should have a digital screen and a whiteboard, a staging area for refreshments, and an internal closet to store tables, chairs, mats and audio-visual equipment to facilitate the efficient room set-up for different types of education activities. The number and size of meeting rooms will depend on the specific patient population.
Telemedicine visits ― using an exam/consult room dedicated for telemedicine encounters with cameras and computer screens that allow viewing by the care provider, patient, and family members or partners.
Multidisciplinary visits ― with exam/consult rooms that can accommodate providers from different disciplines.
This article is an update of a previous post.